Circulating Nurse Quotes

On the landing yesterday’s poster hooked my attention ‘Would they be dead if they’d stayed in bed?’ I had an impulse to rip it down, but that probably constituted conduct unbecoming to a nurse, as well as treason. ‘Yes, they’d be bloody dead,’ I ranted silently. ‘Dead in their beds or at the kitchen table eating their onion a day. Dead on the tram, falling down in the street, whenever the bone-man happened to catch up with them. Blame the germs, the unburied corpses, the dust of war, the circulation of wind and weather, but Lord God Almighty, blame the stars, just don’t blame the dead, because none of them wished this on themselves.

But the decubitus ulcer presents a unique psychological horror. The word “decubitus” comes from the Latin decumbere, to lie down. As a rule, bedridden patients have to be moved every few hours, flipped like pancakes to ensure that the weight of their own bodies doesn’t press their bones into the tissue and skin, cutting off blood circulation. Without blood flow, tissue begins decay. The ulcers occur when a patient is left lying in bed for an extended period, as often happens in understaffed nursing homes. Without some movement, the patient will literally begin to decompose while he or she is still living, eaten alive by their own necrotic tissue.

Wilcox welcomed our interest; we had bottles brought up from every bin, and it was during those tranquil evenings with Sebastian that I first made a serious acquaintance with wine and sowed the seed of a rich harvest which was to be my stay in many barren years. We would sit, he and I, in the Painted Parlour with three bottles open on the table and three glasses before each of us; Sebastian had found a book on wine-tasting, and we followed its instructions in detail. We warmed the glass slightly at a candle, filled it a third high, swirled the wine round, nursed it in our hands, held it to the light, breathed it, sipped it, filled our mouths with it, and rolled it over the tongue, ringing it on the palate like a coin on a counter, tilted our heads back and let it trickle down the throat. Then we talked of it and nibbled Bath Oliver biscuits, and passed on to another wine; then back to the first then on to another, until all three were in circulation and the order of the glasses got confused, and we fell out over which was which, and passed the glasses to and fro between us until there were six glasses, some of them with mixed wines in them which we had filled from the wrong bottle, till we were obliged to start again with three clean glasses each, and the bottles were empty and our praise of them wilder and more exotic. '...It is a little, shy wine like a gazelle.' 'Like a leprechaun.' 'Dappled, in a tapestry meadow.' 'Like a flute by still water.' '...And this is a wise old wine.' 'A prophet in a cave.' '...And this is a necklace of pearls on a white neck.' 'Like a swan.' 'Like the last unicorn.' And we would leave the golden candlelight of the dining-room for the starlight outside and sit on the edge of the fountain, cooling our hands in the water and listening drunkenly to its splash and gurgle over the rocks. 'Ought we to be drunk every night?' Sebastian asked one morning. 'Yes, I think so.' 'I think so too'.

Foucault’s conceptualization of genealogy, which is largely about uncovering subjugated, disqualified knowledge. Foucault identifies two elements within this term. First, it is the buried histories that have been subsumed by “formal systemization.”1 It is these excavated “blocks of historical knowledges” that have been obscured that he terms subjugated knowledges. The second meaning of subjugated knowledges, besides being buried, is forms of knowing that had been disqualified, considered nonsensical or nonscientific. It is “the knowledge of the psychiatrized, the patient, the nurse, the doctor, that is parallel to, marginal to, medical knowledge, the knowledge of the delinquent, what I would call, if you like, what people know.”2 By stating that it is the knowledge of what people know, Foucault is not referring to the taken for granted or dominant form of knowledge circulating but localized, particular, specific knowledges, what we might also call marginalized, experiential, or embodied knowledge.

I’m Jay Powers, the circulating nurse”; “I’m Zhi Xiong, the anesthesiologist”—that sort of thing. It felt kind of hokey to me, and I wondered how much difference this step could really make. But it turned out to have been carefully devised. There have been psychology studies in various fields backing up what should have been self-evident—people who don’t know one another’s names don’t work together nearly as well as those who do. And Brian Sexton, the Johns Hopkins psychologist, had done studies showing the same in operating rooms. In one, he and his research team buttonholed surgical staff members outside their operating rooms and asked them two questions: how would they rate the level of communications during the operation they had just finished and what were the names of the other staff members on the team? The researchers learned that about half the time the staff did not know one another’s names. When they did, however, the communications ratings jumped significantly. The investigators at Johns Hopkins and elsewhere had also observed that when nurses were given a chance to say their names and mention concerns at the beginning of a case, they were more likely to note problems and offer solutions. The researchers called it an “activation phenomenon.” Giving people a chance to say something at the start seemed to activate their sense of participation and responsibility and their willingness to speak up. These were limited studies and hardly definitive. But the initial results were enticing. Nothing had ever been shown to improve the ability of surgeons to broadly reduce harm to patients aside from experience and specialized training. Yet here, in three separate cities, teams had tried out these unusual checklists, and each had found a positive effect. At Johns Hopkins, researchers specifically measured their checklist’s effect on teamwork. Eleven surgeons had agreed to try it in their cases—seven general surgeons, two plastic surgeons, and two neurosurgeons. After three months, the number of team members in their operations reporting that they “functioned as a well-coordinated team” leapt from 68 percent to 92 percent. At the Kaiser hospitals in Southern California, researchers had tested their checklist for six months in thirty-five hundred operations. During that time, they found that their staff’s average rating of the teamwork climate improved from “good” to “outstanding.” Employee satisfaction rose 19 percent. The rate of OR nurse turnover—the proportion leaving their jobs each year—dropped from 23 percent to 7 percent. And the checklist appeared to have caught numerous near errors. In

While further exploring the first floor of the hospital, the friends discovered a dusty room filled with old photographs and crumbling letters; the room was labeled “Archives”. One picture caught their attention — a group of children in tattered school uniforms, their faces frozen in time. The letters spoke of longing and loneliness, and the pain of separation. “These kids do not look like they were at this school according to their own will. They look very sad, almost disturbed.” Emily said as she looked around, cautious of what may be in the basement of this place. Continuing on the main floor, a second room also had file cabinets in it but had no name on the door. Inside the room was an article from the Mountainside times of a time when the hospital had its own tale of tragedy and despair. During the war, the medical facility had been overwhelmed with wounded soldiers, and the staff struggled to provide adequate care. Rumors circulated of a nurse who, unable to cope with the constant death and suffering, succumbed to madness, killing 3 interns and one patient before being shot. It went on to say that since this incident, patients reported she still wandered the desolate corridors, her soft footsteps and distant sobs haunting those who dared to stay overnight. The war department cited an increase in transfer requests out of the hospital citing the interactions with “the inhabitants” that haunt the place. As the friends explored the hospital's abandoned wards and empty rooms, they could almost feel the weight of the past pressing down on them the whole time. Shadows danced along the peeling wallpaper, and the air was filled with an otherworldly chill and the dampness of a bog. Every creak and groan of the building seemed to whisper the stories of those who had lived and died within its walls. Its decrepit walls and shattered windows bathed in the ghostly light of the full moon.

Legal You will learn that there are restrictions placed upon you in some areas. These restrictions are for your own protection. You will be prohibited from administering medications, recording sponge counts, or carrying out direct physician’s orders regarding treatment of a patient out of your scope of practice. As soon as you overstep your limitations and boundaries and perform any of these actions, you are placing yourself in legal jeopardy. Whether functioning under the supervision of a surgeon or a registered nurse, a CST is always part of the surgical team and you must carry out your responsibilities within the scope of your practice. Never try to do a task that does not fall within that realm. All counts are significant and have important legal ramifications. When performing a count, it is crucial to ensure that the count is correct for the patient’s well-being. When you are scrubbed, you count sponges while the registered nurse observes and records the count. At any given time during a surgical procedure, the CST may request a sponge, and possibly a sharps count to take place. If you are assisting the circulating nurse in a nonsterile role, you may assist with the counts as long as the nurse verifies it. In this scenario, the nurse is legally acting as the surgeon’s agent. It is the responsibility of the registered nurse to obtain the required medications for a case. The CST draws the drugs into syringes and mixes drugs when scrubbed; during this process, the proper sequence of medication verification and labeling must occur. In any phase of your responsibilities, there are possible grounds for legal breaches. Shortcuts may cause a patient to suffer tragic complications, even loss of life. Negligence must be avoided. Both as an employed CST and as a student, you carry the responsibility to do no harm. If you should become discouraged in your role or begin to feel this responsibility is overwhelming, it could simply mean that you need a change; it isn’t always the other team players or the place of employment that are at

Transparent tubes divided Phil’s blood into shades of red, fading to straw colored plasma. I watched his fluid swirl past his shoulders and disappear into machines. He offered himself to blood banks all over the city, his plasma rushed to hospitals where it would circulate through other people’s bodies. The map of my love’s tapped arteries would look like a bloodshot eye over the city of Albuquerque. His blood bought us dinner. I dreamed he was my mother, and I nursed his arm. I wrote a poem about it, how I suckled his arm dry like a sore teat.

Teamwork may just be hard in certain lines of work. Under conditions of extreme complexity, we inevitably rely on a division of tasks and expertise—in the operating room, for example, there is the surgeon, the surgical assistant, the scrub nurse, the circulating nurse, the anesthesiologist, and so on. They can each be technical masters at what they do. That’s what we train them to be, and that alone can take years. But the evidence suggests we need them to see their job not just as performing their isolated set of tasks well but also as helping the group get the best possible results. This requires finding a way to ensure that the group lets nothing fall between the cracks and also adapts as a team to whatever problems might arise.

The circulating nurse. This is a Registered Nurse who has been trained to work in the operating room. The circulator helps get the room ready, deals directly with the patient before surgery, positions and preps the patient, helps the anesthesiologist during induction, performs the surgical count with the scrub, and gets supplies during the case. The circulator also has to chart everything that happens during the case and all supplies used. This is done on computer, on standardized forms that are lengthy and considered legal documents. Many OR nurses scrub too, but it’s cheaper for hospitals to use one tech and one nurse as a team, rather than two nurses. The Anesthesiologist, and/ or Certified Registered Nurse Anesthetist. The Primary Surgeon, who may bring an Assisting Surgeon or Resident, or a Physician's Assistant, or a Registered Nurse First Assistant, or a First Assistant who is usually a Certified Surgical First Assistant. Anesthesia Technician, to get supplies ready and support the anesthesiologist. Equipment tech. Some hospitals have a designated person to help with the complicated tables, beds, microscopes, etc.